Case report Year :2023 Month : October Volume : 11 Issue : 4 Page : PC03 - PC05 Full Version Isolated Protein S Deficiency Presenting in Neonatal Inferior Vena Cava as Right Atrial Thrombus: A Case Report Amritha Vinod, Karthikeyan Kadirvel, Amirtha Ganesh, V Premnath 1. Junior Resident, Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. 2. Professor, Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. 3. Professor, Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. 4. Senior Resident, Department of Cardiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.   Correspondence Address : Dr. Amritha Vinod, Junior Resident, Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry-607402, India. E-mail: amrita.arona22@gmail.com   ABSTRACT : Critically ill neonates are at the greatest risk of developing thromboembolic disease. Multiple risk factors have been identified, one of which is isolated Protein S deficiency-a rare cause. The free form of Protein S plays a role in anticoagulation, and its deficiency can manifest as deep venous thrombosis, pulmonary emboli, and superficial thrombophlebitis. Hereby, the authors present a case report of a two-day-old female neonate, born to a gestational diabetic mother, who was initially managed for hypoglycaemia and polycythaemia. On day 4 of life, the baby was shifted to the mother’s side. Twenty-four hours later, she developed late-onset neonatal sepsis with disseminated intravascular coagulation and required management with a mechanical ventilator, Intravenous (IV) antibiotics, and inotropic support. Echocardiography (ECHO) revealed a thrombus (8.9×6.8 mm) attached to the septum of the right atrium, extending from the Inferior Vena Cava (IVC). Treatment with Low Molecular Weight Heparin (LMWH) was initiated, and a follow-up ECHO after three months showed complete resolution of the thrombus. Interval analysis revealed isolated Protein S deficiency with normal Protein C levels. The present report emphasises the importance of interval analysis in identifying causes of Neonatal Thrombotic Events (NTE). Early diagnosis and management can reduce associated morbidity and mortality. Keywords : Central venous catheterisation, Coagulation disorder, Hereditary, Neonatal sepsis, Newborn DOI and Others : DOI: 10.7860/IJNMR/2023/63303.2397 Date of Submission: Feb 19, 2023 Date of Peer Review: May 06, 2023 Date of Acceptance: Jun 02, 2023 Date of Publishing: Dec 31, 2023 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. No PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Feb 22, 2023 • Manual Googling:

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